Hyperparathyroid Flashcards
What is the major effect of parathyroid hormone, both short & long term?
Short - Helps maintain homeostasis of serum ionized calcium (increasing renal reabsorption of Ca, and phosphate excretion in urine, stimulates synthesis of Vitamin D metabolite to absorb Ca in the GI tract)
Long – Osteoclastic activity (to maintain Ca levels)
If a patient presents with muscle cramps, irritability, tetany, seizures, and parasthesias of the hands & feet, what diagnosis are you thinking?
Hypoparathyroidism
What is hypoparathyroidism and what causes it?
LOW ionized calcium, most commonly after a thyroidectomy
What can develop with hypoparathyroidism?
Chronic magnesium deficiency
What would you look for on PE for hypoparathyroidism?
Chvostek’s sign & Trousseau’s sign
Dry, thin nails, hyperactive reflexes
What would be signs & symptoms of chronic hypoparathyroidism?
Lethargy, personality changes, decreased cognitive function, cataracts
What labs would you order for hypoparathyroidism?
Total serum & ionized Ca – LOW PO4 – High Urine Ca – LOW Magnesium! ECG: Prolonged Q-T
If you see low Ca levels on lab work, what other diagnosis would you think of besides hypoparathyroidism?
Malabsorption, Vitamin D deficiency, and Hypomagnesemia
How do you treat hypoparathyroidism?
acute – IV calcium
Chronic – oral Calcium
Magnesium supplement if needed
What is the goal of treatment for hypoparathyroidism?
Maintain serum Ca in low-end of normal range
If a patient’s Ca levels come back and they are elevated what diagnosis would you think of?
Cancer, sarcoidosis, multiple myeloma, Milk-alkaline syndrome (from TUMS) and hyperparathyroidism
What is hyperparathyroidism?
Hypersectretion of PTH – most often a parathyroid adenoma
What can hyperparathyroidism lead to?
Cortical bone resorption = osteoporosis
What are the symptoms of hyperparathyroidism?
Usually none – incidental finding.
If symptoms – “moans, groans, stones, and bones” (psych, abdominal pain [pancreatitis], kidney stones, and fractures)
What can elevated calcium lead to?
fatigue, weakness, altered mental status, nausea, constipation, pancreatitis, and elevated BP
What are the laboratory findings you see with hyperparathyroidism?
Serum Ca > 10.5; inonized Ca > 5.4 (24 hours urine) PO4 – low Alk phos – elevated PTH assay via RIA
How do we treat hyperparathyroidism?
NS + furosemide
Parathyroidectomy
